Hospital Birth Class Registration Form
Hello! I look forward to having you in class. Classes are taught in American Fork, UT on Tuesday evenings at 7pm. Please complete this registration form and I will be in touch with you shortly to confirm your registration and to give you all of the details. Thank you!
Mom's Name
Your answer
Partner's Name
Your answer
Address
Your answer
Email
Your answer
Phone Number
Your answer
Preferred Method of Contact
Mother's Age
Your answer
Estimated Due Date
MM
/
DD
/
YYYY
Number of children
Your answer
Where are you planning to have your baby?
Your answer
Who is your care provider?
Your answer
How do you feel about childbirth classes? What do you hope to learn?
Your answer
How does your partner feel about taking a childbirth class?
Your answer
Anything else you'd like me to know?
Your answer
Which class dates would you like to register for?
How did you hear about this class?
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